Educational Needs Assessment of General Practitioners in Tuberculosis Control and Management.

Background: Tuberculosis is one of the top 10 causes of mortality worldwide. It is also the leading cause of death in HIV-positive patients. In this study, we aimed to assess the educational needs of general practitioners regarding tuberculosis in the North Health Center of Tehran, Iran. Materials and Methods: This quantitative and qualitative study was conducted in 2017. In the quantitative phase, 31 general practitioners from the North Health Center of Tehran were included. The educational needs assessment was performed using the knowledge assessment and self-assessment scales. Data were entered in SPSS version 21 and analyzed using descriptive tests and Pearson’s correlation coefficient test. In the qualitative phase, data were collected by interviewing six managers of tuberculosis monitoring program and analyzed using the content analysis method. Results: The mean score of the knowledge assessment scale was 22.8±6.4. The most and the least important educational needs were related to treatment and general information about tuberculosis, respectively. Moreover, tuberculosis treatment and general information about tuberculosis were the most and the least important educational needs in the self-assessment scale, respectively. There was a poor correlation between the mean scores of self-assessment scale and knowledge assessment scale regarding tuberculosis prevention (P=0.01, r=0.27). Also, a moderate correlation was found regarding tuberculosis screening (P=0.001, r=0.56). However, no significant correlation was found in terms of general information (P=0.31), diagnosis (P=0.43), and treatment (P=0.29) of tuberculosis. Five major themes were extracted in the qualitative phase of the study, including “training time”, “educational content”, “educational references”, “teaching method”, and “organizational factors”. Conclusion: An appropriate educational program should be developed for general practitioners in form of continuing education and educational reform.

Statistics show that the rate of TB and drug-resistant TB in neighboring countries of Iran, such as Pakistan (6), Afghanistan (7), and Iraq (8), is several times higher than Iran.
The fight against TB continues around the world. Despite significant progress in the 19 th and 20 th centuries, TB is still not eradicated in many countries, especially in developing countries (9). Success of the Direct Observed Treatment, Short Course (DOTS) rests on the healthcare system's ability to identify and follow-up suspected TB cases. Delay in diagnosis or initiation of effective treatment leads to the transmission of this infection to susceptible contacts in the community, increases patient expenditure, overburdens the health system, and increases the risk of mortality (2).
In Iran, general practitioners (GPs) working in health centers provide major care for patients with TB under the supervision of infectious diseases specialists, while privatesector physicians are responsible for part of the care.
Adequate knowledge and suitable functioning of physicians are essential to the success of TB control programs (10).
Needs assessment is one of the most controversial concepts in the field of education, training, and curriculum planning (11). It is an essential component of the educational planning process, formulation of plans, and adoption of educational measures (12).
Grant believes that if education, particularly medical education, is based on the needs assessment and function of individuals, it can change their behaviors (13). The results of various studies indicate that physicians' knowledge of TB diagnosis, transmission, and treatment is inadequate (10,14). Therefore, in this study, we aimed to assess the educational needs of GPs in the North Health Center of Tehran, Iran about NTCP. We also aimed to determine the viewpoints of middle and senior managers regarding the implementation of NTCP.

Study Design and Population
This study was conducted in two quantitative and qualitative phases. The quantitative phase was A semi-structured interview was conducted in the qualitative phase of the study. Two main questions were asked in the interviews: • What are the required competencies for GPs in order to manage and control TB?
• What is the most important education requirement for GPs to manage and control TB? Also, the participants were asked to state their comments and suggestions to improve the current status of TB control and management. The validity and reliability of the qualitative phase were different from the quantitative phase.

Ethical considerations
The study protocol conformed to the ethical guidelines of the Declaration of Helsinki.

Statistical analysis
In the quantitative phase, data were imported into SPSS

Quantitative phase
Of

Qualitative phase
In the qualitative phase of the study, a total of 300 semantic units were extracted. After reviewing the units which were similar to each other, they were merged, and nearly 180 initial codes were extracted. The primary codes were classified into categories and subcategories. Finally, five main themes emerged by interviewing the managers: "training time", "educational content", "educational references", "teaching method", and "organizational factors" (Table 3).   Regarding the location of training, three categories were extracted: university classes, health centers, and others (prisons or rehabilitation centers). In this regard, one of the participants remarked: "The course content related to infectious diseases should be specifically designed to make students fully familiar with the theories at university".

Teaching method
The next theme extracted from the interviews was the "teaching method", which was divided into two categories: